Do you have toenail fungus? What can you do about it?

flickr.com/photos/45471172@N08/9714122727

Who gets this?  8% of adults have onychomycosis (toenail fungus).  The prevalence increases with age with more than 50% of those over 70 year of age having it.  It is NOT a sign of poor hygiene or an underlying medical condition, it is largely a cosmetic problem.

There are three types of fungus that can cause onychomycosis: dermatophytes, yeasts and nondermatophyte molds.

How do you know if you have this?  Toenails are characterized by thickened nails and thickened skin beneath the nail.  This thickened skin debris under the nail can cause tenderness and pain when it accumulates over time.  Nails may also become discolored and deformed.

What are your risk factors for getting onychomycosis?  Cigarette smoking, older age, any medical condition that can decrease blood flow to the extremities (like peripheral vascular disease), wearing occlusive footwear, using shared bathrooms, trauma to a toenail.

What is a cure?  Some research consider the nail cured if no fungus can be found on nail culture.  Most people would consider a “cure” when the nail improvement appears normalized.

How can this be treated?  This can be done either by taking oral pills or by putting a medicine on top of the affected nails.  Terbinafine is a pill that has the highest “complete cure rate” of 38%.  Terbinafine is given everyday for 12 weeks for toenails. Checking liver enzymes is suggested by a blood test.  Of the topical medications, they are all known to be expensive and the cure rates are low with complete cure rates at 15% or less.

It is not suggested that the affected nails be surgically removed as this will require a very extended healing time and poor healing rate.

Laser therapy is approved by the FDA, but the clinical cure rates are no better than oral or topical antifungal treatment.